Androgenic juvenile granulosa cell tumor of the ovary with cystic presentation: a case report

Granulosa cell tumors account for approximately 1-2% of all ovarian tumors. There are two types: adult granulosa cell tumor and juvenile granulosa cell tumor. Juvenile granulosa cell tumors constitute 5% of this histological subtype, and the prognosis is good because the majority present as Stage I tumors. The treatment can consist of conservative surgery. Androgen production is rare and produces virilization in women. These tumors are usually solid or predominantly solid. We describe the case of a 13-year-old girl with androgenic manifestations and increased abdominal size. Her plasma testosterone level was elevated. A left adnexal cyst (14.4 x 9.1 x 9.7 cm) was revealed at pelvic ultrasonography. The patient underwent an exploratory laparotomy, revealing a left ovarian cystic tumor. Diagnosis was juvenile granulosa cell tumor.

Granulosa cell tumor; Adolescent; Testosterone; Ovarian Neoplasms; Hyperandrogenism

[1] Bjorkholm E., Silfversward C.: "Prognostic factors in granulosa cell tumors". Gynecol. Oneal., 1980, 11, 261.

[2] Young R.H., Dickersin G.R., Scully R.E.: "Juvenile granulosa cell tumor of the ovary: a clinicipathological analysis of 125 cases" Am. J. Surg. Pathol., 1984, 8, 575.

[3] Young R.H., Dudley A.G., Sculley R.E.: "Granulo、a cell, SertohLeydig cell and unclassified sex cord-stromal tumors associated with pregnancy: a clinicopathological analysis of thirty-six cases" Gynecol. Oneal., 1984, 28, 181.

[4] Calaminus G., Wessalowski R., Harms D., Gobel U.: "Juvenile granulosa cell tumors of the ovary in children and adolescents: results from 33 patients registered in a prospective cooperative study". Gynecol. Oneal., 1997, 65, 447.

[5] Wolf J.K., Mullen J, Burke T.W. et al.: "Radiation treatment of advanced or recurrent granulosa cell tumor of the ovary". Gynecol Oneal., 1999, 7 3, 35.

[6] Uygun K., Aydiner A., Saip P. et al.: "Clinical parameters and treatment results in recurrent granulose cell tumor of the ovary". Gynecol. Oneal., 2003, 88, 400.

[7] Gittleman A.M., Price A.P., Coren C. et al.: "Radiology-Pathology Conference Juvenile granulosa cell tumor". J. Clin. Imaging., 2003, 27, 221.

[8] Castro C.V., Malpica A., Hearne R.H., Silva E.G.: "Case report androgenic adult granulosa cell tumor in a 13-year-old prepubertal patient: a case report and review of the literature". Int. J. of Gynecol. Pathol., 2000, 19, 266.

[9] Outwater E.K., Marchetta B., Wagner B.J.: "Virilizing tumors of the ovary: imaging features". Ultrasound. Obstet. Gynecol., 2000, 15, 365.

[10] Lack E.E., Perez-Atayde A.R., Murthy A.S.K. et al.: "Granulosa theca cell tumors in prernenarchal girls: a clinical and pathological study of ten cases". Cancer, 1981, 48, 1846.

[11] Nakashima N., Young R.H., Scully R.E.: "Androgenic granulosa cell tumors of the ovary. A clinicopathologic analysis of 17 cases and review of literature". Arch. Pathol. Lab. Med., 1984, 108, 786.

[12] Francois Y., Berlier P., Chatelain P., Francois R.: "Turneur virilizante de l'ovaire chez une adolescente". Pediatrie, 1990, 45, 105.

[13] Colombo N., Sessa C., Landoni F. et al.: "Cisplatin, virnblastine, and bleomycincornbination chemotherapy in metastatic granulosa cell tumor of the ovary". Obstet. Gynecol., 1986, 67, 265.

[14] Vassal G., Flamont F., Gailland J.M. et al.: "Juvenile granulosa cell tumor of the ovary in children: a clinical study of 15 cases". J. Clin. Oneal., 1988, 6, 990.

[15] Powell J.L., Otis C.N.: "Case report: management of advanced juvenile granulosa cell tumor of the ovary". Gynecol. Oneal., 1997, 64, 282.

[16] Powell J.L., Johnson N.A., Bailey C.L., Otis C.N.: "Management of advanced juvenile granulosa cell tumor of the ovary". Gynecol Oneal., 1993,48, 119.

[17] Wessalowski R., Spaar H.J., Pape H. et al.: "Successful liver treatrnent of a juvenile granulosa cell tumor in a 4 year old child by regional deep hyperterrnia, systemic chemotherapy, and irradiation". Ginecol. Oneal., 1997, 64, 282.

[18] Airnan J.: "Virilizing ovarian tumors". Clin. Obstet. Gynecol., 1991, 34, 835.

[19] Norris H.J., Taylor H.B.: "Virilization associated with cystic granulosa tumors". Obstet. Gynecol., 1969, 34, 629.

[20] Betson J., Marshall R., Chiffelle T.: "Scleropolycystic (Stein-Leventhal) ovary with an arrhenoblastoma of the opposite gonad" Am. J. Obstet. Gynecol., 1969, 34, 629.

[21] Bou ff et E., Basset T., Chetail N. et al.: "Juvenile granulosa cell tumor of the ovary in infants: a clinicopathologic study of three cases and review of the literature". J. Pediatr. Surg., 1997, 32, 762.

[22] Martinez L., Salmeron M., Carvia R.E. et al.: "Androgen producing luteinized granulosa cell tumor". Acta Obstet. Gynecol. Scand., 1997, 76, 285.

[23] Young, R.H., Oliva E., Scully R.E.: "Luteinized adult granulosa cell tumors of the ovary: a report of four cases". Int. J. Gynecol. Pathol., 1994, 13, 302.

[24] Kitamura Y., Kanegawa K., Muraji T., Sugimura K.: "MR imaging of juvenile granulosa cell tumor of the ovary: a case report" Pediatr. Radial., 2000, 30, 360.

[25] Bognoni V., Quartuccio A., Geraci, P.:'Turnore ovarico a cellule della granulosa di tipo giovanile associato alla gravidanza" Minerva Ginecol., 1997, 49, 283.

[26] Stuart C.E., Dawson L.M.: "Update on granulosa cell tumours of the ovary". Curr. Opin. Obstet. Gynecol., 2003, 15, 33.

[27] Schneider D.T., Calaminis G., Wessalowski R. et al.: "Therapy of advanced ovarian juvenile granulosa cell tumors". Klin. Padiatr., 2002, 214, 173.

[28] Powell J.L., Connor G.P., Henderson G.S.: "Case report: management of recurrent juvenile granulosa ce\1 tumor of the ovary". Gynecol. Oncol., 2001, 81, 113.

[29] Evans III A.T., Gaffey T.A., Malkasian Jr G.D., Annegers J.F "Clinicopathologic review of 118 granulosa and 82 theca cell tumors". Obstet. Gynecol., 1979, 55, 231.